MEDICAL MATTERS/Dr Muiris Houston: Welcome to the first Medical Matters of 2005. It's that time of year for looking forward to what lies ahead.
So I am going to devote today's column to my personal masterplan for the Health Service in 2005. It is also an opportunity to indulge in some off-beat thinking.
My first idea is that we should enable doctors to offer exercise on prescription. Ms Harney should allow exercise be prescribed free on the general medical services (medical card scheme). The type of exercise should be tailored to the individuals medical condition, but in general, a local gym or fitness centre, staffed by qualified exercise therapists would be reimbursed by the Department of Health for the "exercise prescription".
For the private patient, the "prescription cost" of attending the gym could be written off against tax. The government might also like to consider grant aiding such "health service" gyms, perhaps using a public-private partnership model.
As exercise has so many benefits, this initiative would represent both good preventive medicine as well as good therapeutics. It is likely that drug costs would fall as a result, because exercise helps reduce cholesterol levels, it normalises insulin levels in some diabetics and helps both cardiac and peripheral circulation.
It is time that more than lip service was given to the Government's Primary Care Strategy. Every general practice should be a one-stop with nurses, psychologists, therapists, pharmacists and dieticians all available under the one roof. This would make life a lot easier for the patient and enable more seamless cross-referral from one health professional to the other. It would also reduce pressure on hospital services. But it needs a definite initiative to make it happen. Announcing 10 pilot schemes and then failing to follow-through with realistic funding will not work.
The one stop initiative was a good idea when it was announced; it is still a good idea but it needs to be fast-tracked and supported.
Which brings me to the role of local communities in planning health services. Local people and local health professionals should have a formal say in service provision in their areas.
Each one has its own unique priorities. Changing demographics need different responses. It's high time we listened to the service users and providers.
When a generic version of a drug is available, it should be prescribed where possible. To help enforce this, only generic medication will be reimbursed under the medical card and drug refund schemes.
Private patients should be encouraged to avail of the cheapest version of a drug also. In the case of a new drug still under patent, the Irish Medicines Board should be discouraged for licensing a "me-too" version of the drug brought out by a different company. An escalating practice, this has everything to do with market- share and very little to do with patient benefit. Increasingly, drug firms are pouring funds into the practice of me-too marketing to the detriment of truly innovative pharmaceutical research.
Staff recruitment embargoes for front-line healthcare staff must be lifted. It is ridiculous to have a Departmental initiative announced, with appropriate funding, only for the service provider to be told it cannot recruit the individuals it needs because of it current recruitment embargo.
This kind of nonsense reduces the announcement of badly-needed funding to nothing more a PR flim-flam. This is something the Health Service Executive must tackle, as a priority. The bottom line is: services won't improve without increasing front-line staff available to patients.
Much as rightly been written and spoken about the disadvantaged and those who cannot afford medical care because they are just above the medical card income limit. But an argument can be made that those who pay for private health insurance are also disadvantaged. Although they contribute high taxation to the public health service, they are nevertheless discouraged from using it except in emergencies. However, the Department of Health has a policy of largely ignoring private health services. It does not monitor private hospitals; if asked to comment on private facilities, it refuses to do so. It is time we had a unified approach to health care.
The aim must be to provide a first-class service accessible by all. Anything less will perpetrate the inequities which have riddled health services since the setting up of the Voluntary Health Insurance Board. Some of us may pay and some of us may get it free, but the bottom line must be that every citizen has equal access to the same level of health service in the State.